Mid potency topical corticosteroids

Betamethasone dipropionate was patented by Merck in 1987 as an augmented cream/lotion, Diprolene in the ., and Disprosone in Europe. [7] These patents expired in 2003 and 2007 respectively leading to generic production of betamethasone dipropionate. During this time other topical corticosteroids such as triamcinolone acetonide and clobetasol propionate also became available as generic creams. Merck filed for "pediatric exclusivity" in 2001 launching a clinical trial to prove betamethasone dipropionate's safety and efficacy for use in pediatrics. [8]

The systemic exposure to pimecrolimus from Elidel Cream, 1% was investigated in 28 pediatric subjects with atopic dermatitis (20%-80% BSA involvement) between the ages of 8 months-14 years. Following twice daily application for 3 weeks, blood concentrations of pimecrolimus were <2 ng/mL with 60% (96/161) of the blood samples having blood concentration below the limit of quantification ( ng/mL). However, more children (23 children out of the total 28 children investigated) had at least one detectable blood level as compared to the adults (12 adults out of the total 52 adults investigated) over a 3-week treatment period. Due to the erratic nature of the blood levels observed, no correlation could be made between amount of cream, degree of BSA involvement, and blood concentrations. In general, the blood concentrations measured in adult atopic dermatitis subjects were comparable to those seen in the pediatric population.

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Different formulations have been developed in an effort to enhance the delivery of topical corticosteroids. Betamethasone valerate in a foam had superior efficacy for scalp psoriasis and was preferred by patients when compared with betamethasone valerate lotion [ 20 ]. The foam becomes a liquid on contact with skin and is also well tolerated by patients with trunk and extremity psoriasis [ 21 ]. A clobetasol propionate spray is also available; like foams, sprays are easy to apply to large areas [ 22 ]. The main advantage of these newer preparations is likely greater patient acceptance, which may translate into greater adherence; the main disadvantage is cost.

Mid potency topical corticosteroids

Different formulations have been developed in an effort to enhance the delivery of topical corticosteroids. Betamethasone valerate in a foam had superior efficacy for scalp psoriasis and was preferred by patients when compared with betamethasone valerate lotion [ 20 ]. The foam becomes a liquid on contact with skin and is also well tolerated by patients with trunk and extremity psoriasis [ 21 ]. A clobetasol propionate spray is also available; like foams, sprays are easy to apply to large areas [ 22 ]. The main advantage of these newer preparations is likely greater patient acceptance, which may translate into greater adherence; the main disadvantage is cost.